Hong Kong Journal of Emergency Medicine

Volume 11 Number 1, January 2004

Thrombolysis as a therapeutic modality in cardiac arrest

SY Tay

Introduction: In recent years, thrombolysis has emerged as a potentially promising treatment for cardiac arrest. Patients with cardiac arrests from myocardial infarction or pulmonary embolism, as well as out-of-hospital cardiac arrests, were reported to have improvement in both survival and neurologic outcome after being treated with thrombolysis. This paper aims to review the available literature on the use of thrombolysis in cardiac arrest. Method: Study of papers from PubMed literature search for all articles with terms related to thrombolysis and cardiac arrest in title or abstract. Results: Thrombolytics are thought to act by lysing both macroscopic clots and microthrombi, particularly in the cerebral microcirculation, thus alleviating or reversing post-arrest cerebral no-reflow. Their use in cardiac arrest has been restrained by concerns over their safety after cardiopulmonary resuscitation, in particular bleeding-related complications, although these concerns seem to have been misplaced. Conclusions: Thrombolysis for cardiac arrest is likely to be most efficacious in a pre-hospital environment, and future research should be directed to this setting. (Hong Kong j.emerg.med. 2004;11:26-34)

Keywords : Cardiopulmonary resuscitation, fibrinolysis, resuscitation

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